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Process of care and outcome of care quality measures

For all of the process of care and outcome of care quality measures that show whether patients improved, HIGHER percentages are better. For the health care utilization measures, LOWER percentages are generally better. Consider each measure carefully. For example:

Lower rates of patients requiring treatment in an emergency department or hospitalization are generally better because agency staff, in many instances, can prevent the need for a higher level of care. Similarly, you want to avoid the need for urgent care, like in an emergency department, and good care from a home health agency often does that.

However, timely hospitalization is an important safety net and must be ensured for each individual patient who requires hospital-based treatment or becomes critically ill and needs more extensive care. When a higher level of care is needed quickly, home health agency staff must be able to ensure patients get medical care that cannot be provided at home. For that reason, in comparing home health agencies on the basis of what percentage of each agency’s patients got urgent care or were hospitalized, it would make sense to choose an agency that had lower than average percentages for each category of care. A wise consumer would want to see low percentages, but if no patients get emergency care, that would also cause concern and should prompt questions to the agency about how it handles very sick or injured patients.

It's important to know that small differences in the percentages usually don’t mean that one agency is significantly better or worse. It's better to look at larger differences. Percentages may be affected by such factors as how many patients are included in the calculation of the rate and this doesn’t necessarily reflect the quality of care provided.

For each of the quality measures, any percentages that are extremely different should raise a flag that you need more information. For instance, if for most agencies in your county, 25 - 35% of patients were hospitalized during a one year period, an agency where only 5% of patients spent time in a hospital during the same period should make you wonder how that could be accomplished. It may mean that some patients didn’t get the care they needed. For measures where higher percentages are better, if one agency has a score of 90% on an outcome measure, and the other agency has a score of 60% on this same outcome measure, you would want to find out why and how.

Generally, when comparing the performance of home health agencies, if an agency has missing data or very high (90-100%) or very low (0-10%) percentages for a performance measure that's important to you, you should get more information by calling the home health agency or the State Survey Agency, found in Medicare Helpful Contacts under Home Health Agency, that licenses or monitors its performance.

Patients should be encouraged to discuss the information they find on Home Health Compare with their doctor or other health care provider, and with the home health agencies they're considering.